Questions about Infection

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This question by TK was moved here from the Antibiotics and Massage forum:

TWO QUESTIONS FOR DR SHOSKES

A) THE CONTEXT: The primary trigger for my symptoms is Ejaculation. Immediately following ejaculation, there is a 12-18 hour period of relative relief (perhaps because release of fluid offsets swelling and reduces pressure on nerves). This is followed by a 12-18 hour period of heightened symptoms, which then declines. This pattern has remained consistent for a number of months.

THE QUESTION: have you observed smoldering infections which are sequestered until the contractions associated with ejaculation push bacteria into the tissue, provoking an increased inflammatory response which builds up and then subsides over a 24-36 hour period? Is this known to occur in cases where infection is documented?

Although you asked Dr Shoskes this question, I'll answer too if I may: No, I don't believe this is a credible scenario. I know as much about this disease as any layman alive, and I've never heard of this before or seen any uro or research cite the possibility. Men with CBP do not report this, and if anyone would report it, it's them (if trapped bacteria getting released was the cause). In fact post-ejac. pain is a classic hallmark of CPPS.

B) THE CONTEXT: All urine cultures and have been consistently negative since the beginning of my experience with prostatitis. Also, no WBC observed in Urine. (Post-massage urine was never tested). There have been no episodes of cloudy urine observed at all over the 8 month experience of prostatitis. But several days prior to onset, I did notice 1 episode of heavy/cloudy urine.

THE QUESTION: to the extent that urinary tract infections involve pyuria, is it common for this pyuria to be confined to a single episode? If so, would a single episode be characteristic of any particular organism(s) that have been associated with prostatitis?

You should not asscoiate a single epsiode of cloudy urine with pyuria. Many things can cause cloudy urine -- I get it frequently from loading up on fruit. Here's an experiment: eat a pound of dried pineapple (Trader Joes) and watch your urine. And lastly, I have never heard of a single episode of pyuria, and certainly not in relation to CPPS. I suggest you drop this line of reasoning if you want to progress to a deeper understanding of your condition.

CULTURES: the only cultures taken were from Semen as opposed to EPS and these were negative. (I have some doubts as to the profficiency of the labwork).

I don't know how many times I've seen this: patients doubting lab work because the lab work does not turn out the way they feel it should.

[TK]

CULTURES: the only cultures taken were from Semen as opposed to EPS and these were negative. (I have some doubts as to the profficiency of the labwork).

I don't know how many times I've seen this: patients doubting lab work because the lab work does not turn out the way they feel it should.

Thanks. I do understand that the overwhelming majority of chronic prostatitis / chronic pelvic pain syndrome cases are not bacterial in origin. But I also understand that it can be difficult to obtain cultures even in that fraction of cases where bacteria may have been involved. Whereas some labs have refined their practices to achieve the most reliable possible results, I was unfortunately sent to a place that was physically filthy and (long story -- otherwise questionable as a clinical setting). Hence a rational doubt about the value of the results.

have you observed smoldering infections which are sequestered until the contractions associated with ejaculation push bacteria into the tissue, provoking an increased inflammatory response which builds up and then subsides over a 24-36 hour period? Is this known to occur in cases where infection is documented?

Although you asked Dr Shoskes this question, I'll answer too if I may: No, I don't believe this is a credible scenario. I know as much about this disease as any layman alive, and I've never heard of this before or seen any uro or research cite the possibility. Men with CBP do not report this, and if anyone would report it, it's them (if trapped bacteria getting released was the cause). In fact post-ejac. pain is a classic hallmark of CPPS.

Thanks. Once again, I understand this. As briefly as possible: in my own narrow experience, I have been able to reduce length and severity of post-ejac symptoms by reducing duration of muscle contractions following ejaculation (see recent exchange with Dr. Dimitrakov under "Muscle Tension). So "physical squeezing" seems to play arole in the mechanism. Perhaps inflamed tissue is severely perturbed, and this leads to infiltration of monocytes over a 24 hour period... leading to swelling, pressure on nerves, symptoms. But I also wondered if physical squeezing could hypotheticially flush out bacteria (perhaps sequestered in biofilm). And since Dr. Shoskes does work with known bacterial cases, I thought that he might be able to address this.

to the extent that urinary tract infections involve pyuria, is it common for this pyuria to be confined to a single episode? If so, would a single episode be characteristic of any particular organism(s) that have been associated with prostatitis?

You should not asscoiate a single epsiode of cloudy urine with pyuria. Many things can cause cloudy urine -- I get it frequently from loading up on fruit. Here's an experiment: eat a pound of dried pineapple (Trader Joes) and watch your urine. And lastly, I have never heard of a single episode of pyuria, and certainly not in relation to CPPS. I suggest you drop this line of reasoning if you want to progress to a deeper understanding of your condition.

From what I have read, there are indeed many reasons for "cloudy urine", but again I had hoped to ask whether there are indeed SOME occasions when an infection is accompannied by a single instance of pyuria.

As to my "line of reasoning", thanks largely to the help of your excellent website, I concluded some time ago that inflammation, together with factors relating to nerves and muscle tension, should be the primary focus. This emphasis continues, even as I ask questions that relate to bacteria.

I do understand why questions that relate to the "bacterial theory" sometimes do raise legitimate flags of concern. I hope that my two original questions to Dr. Shoskes can be separated from these concerns.

Apology for length of post.

Thank you once again!

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...I was unfortunately sent to a place that was physically filthy and (long story -- otherwise questionable as a clinical setting).

That would make your case very unusual.

I have been able to reduce length and severity of post-ejac symptoms by reducing duration of muscle contractions following ejaculation.... I also wondered if physical squeezing could hypotheticially flush out bacteria (perhaps sequestered in biofilm).

A number of men have reported controlling p.e. pain by relaxing pelvic muscles during ejaculation, so you are on to something here. However, on the biofilm side, I doubt if you can squeeze bacteria from a biolfim. We all have biofims forming on our teeth, so you can see it's not the sort of structure to respond to gentle contractions.

I had hoped to ask whether there are indeed SOME occasions when an infection is accompanied by a single instance of pyuria.

Infections don't self-heal, AFAIK, so it's most unlikely.